title: Adjuvant chemotherapy after reduced craniospinal irradiation dose in children with average-risk medulloblastoma: a 5-year follow-up study.
abstract: OBJECTIVE
  This study was undertaken to determine the effect of adjuvant chemotherapy combined with reduced-dose craniospinal irradiation (CSI) on survival and neurocognitive sequelae of radiotherapy (RT) in patients with average- risk medulloblastoma above the age of 3 years.
  
  
  METHODS
  Thirty-three children between 3 and 10 years of age with average-risk medulloblastoma were treated with postoperative reduced-dose CSI (24.0 Gy) and 30.6 Gy of local RT (total of 54.6 Gy) and then with adjuvant chemotherapy consisting of cisplatin, vincristine, and cyclophosphamide every 4 weeks for 8 cycles.
  
  
  RESULTS
  At 5 years, event-free survival (EFS) was 79%, while overall survival (OS) was 85%. Sites of relapse were local in 3%, neuraxis in 9% and both local and neuraxis in 9% of the patients. Chemotherapy was well tolerated. Hematopoietic toxicity was the most predominant side effect followed by vomiting and ototoxicity. No grade III or IV nephrotoxicity or neurotoxicity and no treatment-related deaths were encountered. Insignificant decline of intelligence quotient (IQ) was reported in 28.6% of the patients.
  
  
  CONCLUSIONS
  The preliminary results of adjuvant chemotherapy after reduced-dose CSI in average-risk medulloblastoma patients are encouraging and effective, and can be applied safely with acceptable toxicity.
authors.affiliation: Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
authors.forename: H A
authors.initials: HA
authors.lastname: Wahba
authors.forename: M
authors.initials: M
authors.lastname: Abu-Hegazy
authors.forename: Y
authors.initials: Y
authors.lastname: Wasel
authors.forename: E I
authors.initials: EI
authors.lastname: Ismail
authors.forename: A S
authors.initials: AS
authors.lastname: Zidan
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002528:Cerebellar Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D002945:Cisplatin / Q000008:administration & dosage; D003071:Cognition / Q000187:drug effects / Q000528:radiation effects; D016371:Cranial Irradiation / Q000009:adverse effects; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008527:Medulloblastoma / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D009364:Neoplasm Recurrence, Local; D011446:Prospective Studies; D011829:Radiation Dosage; D013997:Time Factors; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D014750:Vincristine; D003520:Cyclophosphamide; D002945:Cisplatin